DESCRIPTION: (Applicant's Description) My research plan focuses on gastrointestinal cancer screening and surveillance. The integrated research approach targets three clinical areas (screening for colorectal cancer, and surveillance of patients with Barrett's esophagus and ulcerative colitis). The study methods link decision modeling with clinical research to answer important clinical questions regarding screening and surveillance. The integrated research process includes: 1) Identifying the relevant screening and surveillance questions for study, 2) structuring a decision analytic model (using published literature) to answer the study questions, 3) identifying the optimal strategy given the available data, 4) targeting critical parameters in the model for which there are incomplete data, 5) designing and implementing observational studies for primary collection of these data, and 6) integrating the results of the clinical studies into decision models to provide clinicians and policy makers with new, patient specific data about the optimal management strategy. Research projects focus on the development of the acceptable and cost-effective colon cancer screening strategies for veterans. Future projects will determine the costs and resource needs to implement these preferred strategies. Another study evaluates risk factors for presentation with late stage colorectal cancer. If modifiable factors such as access to screening, or physician delay in follow-up of positive screening tests are identified, then interventions can be made to improve access and reduce delay with the aim of reducing colorectal cancer mortality. Ongoing and future studies will examine the health related quality of life of patients with Barrett's esophagus and ulcerative colitis using standardized measures (SIP, SF-36, RFIPC, TTO). The results will be summarized and incorporated into the decision models to determine their effect on surveillance strategies. The other critical component of my career plan is the structured mentoring program for gastroenterology/health services research fellows. The program integrates coursework leading to a Master of Science in Clinical Research with a mentoring program that provides the fellow with the opportunity for patient centered research experience. There is a gradual increase in his/her research independence under my supervision, leading to the design and execution of his/her own research project, including data analysis, abstract and manuscript preparation and presentation of the study results at a national meeting.